In a given year, depression affects nearly 10 percent of Americans over the age of 18. Its effects can be devastating, leading to disability, chronic illness and even suicide. Depression is, however, highly treatable, with 80 to 90 percent of those treated for depression showing improvement in symptoms. Medication is one treatment alternative that can bring about improvement in depression symptoms. There are a number of medical treatment options available, so your doctor can work with you to figure out the right medicine for you.
Selective Serotonin Reuptake Inhibitors
Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressant medications that improve mood by increasing the amount of the neurotransmitter serotonin in the brain. SSRIs carry some risk of side effects, including nausea, dry mouth, rash, headache, agitation, sexual side effects and sleep disturbances; however, they are usually the first choice among depression medications because these side effects are less serious than those presented by other depression drugs.
SSRIs used to treat depression include fluoxetine, paroxetine, sertraline, escitalopram and citalopram.
Serotonin Norepinephrine Reuptake Inhibitors
Serotonin norepinephrine reuptake inhibitors (SNRIs) are called dual reuptake inhibitors because they work on two of the neurotransmitters associated with depression--serotonin and norepinephrine. By inhibiting the reabsorption of these neurotransmitters by brain cells, they increase the amount found in the brain, thus alleviating mood. Venlafaxine and duloxetine are two SNRIs commonly prescribed for depression. Side effects are generally similar to those seen in SSRIs.
Tricyclic Antidepressants and Heterocyclics
Tricyclic antidepressants (TCAs) and heterocyclics are older antidepressants that inhibit the reuptake of serotonin and norephinephrine in the brain just like SNRIs; however, they show nonspecific effects on other neurotransmitters, as well, increasing the risk for a number of potentially more serious side effects. These side effects include low blood pressure, urinary retention, tremors and delirium. TCAs and heterocyclics may also interact with anti-seizure medication (anticonvulsants) or medications commonly prescribed to treat heart problems, so depressed persons with either of these two conditions should not take TCAs or heterocyclics.
TCAs available to treat depression include amitriptyline, desipramine, imipramine, doxepin, nortriptyline, protriptyline and trimipramine.
Heterocyclics for depression include maprotiline hydrochloride, amoxapine, and trazodone hydrochloride.
Monoamine Oxidase Inhibitors
Like SNRIs, TCAs, and heterocyclics, monoamine oxidase inhibitors (MAOIs) are antidepressants that act on the neurotransmitters serotonin and norepinephrine. The way in which they work, however, can cause serious, unwanted side effects such as fatally high blood pressure, muscle spasms, weakness, decreased urine output, blurred vision, increased perspiration and dizziness.
MAOIs sometimes prescribed for depression include isocarboxazid, tranylcypromine, phenelzine and selegiline. Selegiline is the first transdermal skin patch for depression.
Norepinephrine Dopamine Reuptake Inhibitors
Norepinephrine Dopamine Reuptake Inhibitors (NDRIs) are another type of dual reuptake inhibitor that increases the amount of norepinephrine and dopamine in the brain by inhibiting their reabsorption by brain cells. The only NDRI currently approved for the treatment of depression is bupropion, and it is available in immediate release (taken 3 times a day), slow or sustained release (taken 2 times a day), and extended release (taken once a day) forms.
Atypical Antipsychotics
Atypical antipsychotics are sometimes prescribed to treat cases of depression that do not respond to other depression medications. These are sometimes called treatment-refractory or treatment-resistant cases.
According to a study published in a January 2005 issue of the "Journal of Clinical Psychiatry," atypical antipsychotics such as risperidone, quetiapine, olanzapine and ziprasidone may be effective in improving symptoms of treatment-resistant and bipolar depression. These medications are especially effective when they are combined with other drugs or behavioral therapy.
One hybrid atypical antipsychotic/SSRI is made from olanzapine and fluoxetine, and it is currently approved for the treatment of bipolar depression only.
